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48 Behavior of Divers and Recommendations of Otolaryngologists Concerning Diving: Pilot Study

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48 Behavior of Divers and Recommendations of Otolaryngologists Concerning Diving: Pilot Study SVEIKATOS MOKSLAI / HEALTH SCIENCES IN EASTERN EUROPE ISSN 1392-6373 print / 2335-867X online 2020, 30 tomas, Nr.1, p. 48-55 48 VISUOMENĖS SVEIKATA / PUBLIC HEALTH DOI: https://doi.org/10.35988/sm-hs.2020.007 BEHAVIOR OF DIVERS AND RECOMMENDATIONS OF OTOLARYNGOLOGISTS CONCERNING DIVING: PILOT STUDY Liubov Kornilenko1, Jelena Stanislavovienė1, Irina Arechvo2 1Faculty of Medicine, Vilnius University, 2Department of Ear, Nose and Throat Diseases, Republican Vilnius University Hospital, Lithuania Keywords: behavior of divers, diving contraindications, after the stapedoplasty, is different; 15% of the inter- ear barotrauma. viewed doctors would recommend stopping diving for a definite period. Despite the recommendations Summary of doctors, 17.9% of divers continued to dive. The aim of the study is to estimate the possible risky Conclusions. This study shows that the behavior of behavior of Lithuanian divers and its relation to ear divers regarding the hearing health is often quite ri- damage as well as identify the opinions of Lithuanian sky. Lithuanian otolaryngologists are lacking con- otolaryngologists concerning contraindications and sensus of opinion on contraindications for diving. recommendations in the diving field. Material and methods. The authors compiled two Introduction separate questionnaires for Lithuanian divers and Diving is one of the activities that are the fastest growing otolaryngologists; in total, 84 questionnaires were in popularity. There are more than 10 million certified divers completed. Statistical tests were used to detect the worldwide [1], but the exact number of amateur divers in difference among answers of respondents who have Lithuania is unknown (the country has more than 20 di- distinct sociodemographic characteristics or different ving clubs) [2]. Due to significant air pressure changes, the diving/consulting experience. main health problems of divers are associated with ears and Results. It was revealed that 47.5% of divers experi- sinuses [1]. However, the residency of Lithuanian otolaryn- enced difficulties while equalizing the air pressure. gologists does not involve all aspects of diving medicine. More than half of the divers (57.9%) ignored this Because of the lack of doctor’s experience, difficulties can embarrassment and continued diving. Ear pain was occur while giving advice to divers. It is generally accepted felt by 37.5% of the respondents during their diving that common ear and nose diseases, e.g. chronic otitis media session. Half of the divers consulted a doctor because with perforation, chronic rhinosinusitis and nasal polyposis of the pain, others did not pay attention and procee- are contraindications for diving. However, modern treatment ded the diving. The third of the interviewed divers methods may increase the expectation for a full recovery and were diving though they had rhinitis. Most of them even to restore the ability to dive in many cases. Additionally, were diving without any medications. Only 13% of there is still no consensus of opinion regarding how long the those who experienced dizziness consulted a doctor. underwater activity should be prohibited after the usual oto- Absolute contraindications to dive are a tympanic laryngological procedures. The doctors should know about membrane perforation (90.9%), myringotomy tube the strong desire of divers to practice diving despite chronic inserted into a tympanic membrane (79.5%), and Eus- conditions. Previous studies have shown that divers continue tachian tube dysfunction (61.4%); these disorders are to dive despite suffering from contraindications [3,4]. most often reported by the interviewed otolaryngolo- The aim of this paper is to reveal the presence or absence gists. In this survey, 61.3% of the otolaryngologists of risky behavior of Lithuanian divers and opinions of otola- declared they would allow diving if there were no ryngologists about contraindications and recommendations symptoms of vertigo in the past 3–6 months. The concerning the diving activity. The researchers of this study opinion of otolaryngologists on diving in the case of believe that the results of it will help the communities of acute rhinitis, as well as on the returning to diving divers and otolaryngologists to understand each other better. Žurnalo tinklalapis: http://sm-hs.eu Correspondence to: Jelena Stanislavovienė, e-mail: [email protected] 49 Materials and methods of the interviewed otolaryngologists reported that they had This study has been carried out from July to October in consulted divers in the past 12 months. The largest number 2015. Two separate questionnaires were created and sent of consulted divers per specialist within a year is 10 people to Lithuanian diving clubs as well as to otolaryngologists (Table 1). via e-mail. The questionnaire for divers included questions In the study, 40 questionnaires which had been comple- concerning demographic data (questions), diving history ted by the divers were used as well. The major part of these (), symptoms of ear disorders (), risk factors for the develo- respondents includes men who have approximately 6 years pment of ear diseases and diving habits that might affect the of diving experience (Table 2). Another characteristic of occurrence of otological complications (). Knowledge of the the interviewed divers is that sixty percent of them have a divers about their handling different underwater situations higher education. Most respondents (95%) have at least one () was evaluated as well as frequency of their consultations diving certificate. with medical specialists () and compliance with the recom- Study of otolaryngologists: contraindications for di- mendations of doctors (). ving and special ear conditions while diving. The con- In the questionnaire, otolaryngologists were asked to ditions noted by otolaryngologists as the absolute contra- provide their sociodemographic data (), information concer- indications for diving are presented in the Figure 1. The ning their work experience (), recommendations for divers, major part of the ENT specialists noted that open tympa- contraindications to diving () and their knowledge regarding nic membrane perforation and tube myringotomy are total the treatment of diving-related diseases (). contraindications to diving. Besides, about half of intervie- All eighty-four submitted questionnaires were completed wed specialists think that the records of Eustachian tube and used in the analysis; the number of respondents is 40 dysfunction and open mastoidectomy in patient’s medical divers and 44 otolaryngologists. The data were analyzed history are contraindications for diving and only several using IBM SPSS Statistics software, version 21.0. ANOVA doctors would prohibit the diving if a patient had other ear was employed to compare the means of continuous variables. health conditions.. The choice of a particular questionnaire’s Chi-square and Fisher’s exact test were used to obtain signi- answer overall does not depend on the doctor’s job experi- ficant differences in proportions of categorical variables. In ence, a number of consulted divers per year, respondent’s this paper, the exact test results are presented only using the workplace. cases in which statistically significant differences between In regards to whether patients can continue diving after the groups can be observed (p < 0.05). a surgery (stapedoplasty), 38.6% of the interviewed oto- laryngologists (IOs) proposed the first consultation three Results months after the surgery, 34.1% suggested seeing the doctor This study includes 44 questionnaires completed by after one year, and 20.5% said that diving is contraindicated otolaryngologists whose average work experience is 20.01 after the stapedoplasty. The answer choice is related to the years (SD = 12.71). Тhe most of them (24 respondents) duration of work experience. The average work experience have worked both in outpatient departments and hospitals, of respondents who recommended diving one year after the others (17 interviewees) have worked entirely in outpa- the stapedoplasty is 28.07 years (SD = 12.2) vs. 14.82 ye- tients departments, and only 3 questioned otolaryngologists ars (SD = 10.66) of work experience of those doctors who mentioned a hospital as their sole workplace. Only 34.1% recommended diving 3 months after the surgery (F = 5.05, p < 0.05). Table 1. Characteristics of the interviewed ear, nose and throat The research reveals the opinion of otolaryngologists (ENT) specialists (otolaryngologists) concerning the workplace concerning the about diving when atrophic eardrums can and the number of divers they had consulted per year (n = 44). Table 2. Characteristics of the interviewed divers concerning the Characteristic Absolute % age, sex, diving depth and diving experience (n = 40). numbers Workplace Characteristic n = 40 Outpatient department 17 38.6 Average age 35.8 years (SD = 11.142) Hospital 3 6.8 Sex Outpatient department and hospital 24 54.5 Men n = 30 (75 %) Consulted divers per year Women n = 10 (25 %) None 29 65.9 Average diving depth 22.23 meters (SD = 8.122) From 1 to 10 15 34.1 Average diving experience 6.5 years (SD = 3.83) 50 Figure 1. Absolute contraindications for diving noted by the interviewed otolaryngologists. be seen otoscopically: there are 31.8% interviewed speci- 12.5% of doctors having 16-30 years of work experience alists who were convinced that diving causes ear traumas, and by 12.5% of those having from 31 to 45 years of work so their advice for patients is to stop diving;
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